Human malignancy-associated nucleolar antigen as a marker for tumor cells in patients with acute leukemia

Tumor burden in adult patients with acute leukemia is assessed using the percentage of blast cells in the bone marrow or blood. It is clear, however, that not all blast cells are leukemic cells, especially during rapid marrow regeneration. Similarly, some leukemia cell lines have been shown to differentiate in vitro, and the same process also occurs in vivo. Therefore, the leukemic burden may be due to more differentiated cells as well as to blast cells. The purpose of this study was to investigate whether the human malignancy-associated nucleolar antigen (HMNA) could be used as a marker for leukemic cells and to examine its potential as a diagnostic tool. The proportion of HMNA-positive cells in the bone marrow of patients with acute leukemia was determined by indirect immunofluorescence with antibodies to HMNA and was compared with the differential counts routinely made in the clinic laboratory. The percentages of HMNA-positive cells among the nucleated cells in the marrow of 72 patients with clinical evidence of leukemia were significantly higher (range 9%-98%, median 83%) than those observed for nonleukemic individuals (range less than 0.05%-2.5%, median 1%) or for fractions of marrow cells from normal volunteers enriched for normal early progenitor cells (less than or equal to 2%). Patients with leukemia in remission had a lower percentage of HMNA-positive cells (range 0%-83%, median 3%). The percentage of HMNA-positive cells increased as patients approached relapse. Although the percentage of HMNA-positive cells was related to the percentage of blast cells in the bone marrow of the patients with leukemia, some partially differentiated cells were also HMNA-positive in some specimens, and some blastic cells were HMNA-negative in other specimens. These studies indicate the potential usefulness of HMNA as a marker for leukemic cells.

Narcotics and spasm of the sphincter of Oddi. A retrospective study of operative cholangiograms

The operative cholangiograms of 112 patients undergoing elective cholecystectomy were reviewed independently and retrospectively by two radiologists who were not aware of the anaesthetic technique used. Fifty four patients who received opioid drugs either pre- and/or intra-operatively comprised one study group whilst 58 patients who received no opioids comprised the other. Spasm of the sphincter of Oddi was observed in two patients in the opioid group and in one patient in the non-opioid group. The use of opioid drugs as part of the anaesthetic management for cholecystectomy did not appear to interfere with the radiological interpretation of operative cholangiography nor to increase the low incidence of spasm of the sphincter of Oddi.

Monoclonal antibodies to mitotic cells

Certain proteins or activities are present in mitotic cells but not in interphase cells. These proteins may be synthesized or activated, or both, just prior to mitosis and are responsible for the breakdown of the nuclear envelope and the condensation of chromosomes. To learn more about the nature of these proteins, we raised monoclonal antibodies to mitotic cells. Spleen cells from mice immunized with a 0.15 M NaCl extract of synchronized mitotic HeLa cells were fused with SP2/0-Ag14 mouse myeloma cells, and hybrids were selected in medium containing hypoxanthine, methotrexate, thymidine, and glycine. Two different hybridoma clones secreting antibodies reactive with mitotic and meiotic cells from every species tested were isolated. Chromosomes as well as cytoplasm in mitotic cells reacted with the antibodies, as detected by indirect immunofluorescence. The proteins from mitotic cells were separated by electrophoresis in NaDodSO4/polyacrylamide slab gels, transferred to nitrocellulose sheets, and stained immunochemically. The two antibodies, designated MPM-1 and MPM-2, recognize a family of polypeptides with apparent molecular masses of 0.40 to greater than 200 kilodaltons (kDa). Both antibodies reacted strongly with three polypeptide bands of 182 kDa, 118 kDa, and 70 kDa. Only mitotic cells exhibited the protein bands that were recognized by the antibodies. All these bands were found to be phosphoproteins as shown by 32P labeling and autoradiography and their removal by alkaline phosphatase treatment.

Leukemic cell colony formation in soft agar by bone marrow cells and peripheral blood cells from untreated acute leukemia patients

An in vitro culture technique for colony formation of marrow cells and peripheral blood cells from untreated acute leukemia patients and from patients in relapse is described. The colonies from bone marrow cells of an untreated acute myelogenous leukemia (AML) patient were demonstrated to be of leukemic origin by cytogenetic analysis. Cells obtained from colonies of leukemic origin contained the human malignancy-associated nucleolar antigen (HMNA) as detected by indirect immunofluorescence. This nucleolar antigen was not present in marrow or peripheral blood cells or cells from colonies of marrow from hematologically normal individuals. Colonies could be grown from over 70% of the marrow and peripheral blood samples from untreated acute leukemia patients. The median number of colonies obtained was 75 per 10(5) marrow cells from patients with AML. In 1/3 of the cases an increased number of colonies could be grown from marrow cell suspensions kept in liquid culture for 5 days. This is indicative of the proliferative capacity of the colony forming cell population. This assay may be useful for detection of residual clonogenic leukemic cells in marrow and peripheral blood cell suspensions.

Detection of leukemic cell colonies in agar plates by immunostaining for human malignancy-associated nucleolar antigen

We have developed an indirect immunofluorescence technique to stain individual colonies in situ in agar to detect the presence of a human malignancy-associated nucleolar antigen. Bone marrow and peripheral blood cells from leukemia patients who were untreated or suffering relapse were used as a source for colony formation. The agar layer containing the colonies was stabilized by overlaying it with an additional agar layer. Cells in the colonies were fixed with methanol, rehydrated, and incubated for prolonged periods in both the primary and the secondary antibodies. The agar was then transferred onto a glass slide, air dried, and examined using a fluorescence microscope. The method is widely applicable for staining colonies in situ in agar with both polyclonal and monoclonal antibodies.

Patient administration of I.V. buprenorphine for postoperative pain relief using the "Cardiff" demand analgesia apparatus

In 51 patients undergoing elective abdominal surgery, analgesia was provided for the first 24 h after surgery by bolus injections of buprenorphine 0.1 or 0.2 mg given i.v. on patient demand using a patient-operated syringe driver (the "Cardiff" palliator). Excellent analgesia was reported by 47 patients. Four elderly patients had difficulty in operating the demand apparatus. In two other patients, clinically significant ventilatory depression necessitated abandoning the trial. Although there was a high degree of patient and staff acceptance of the method, the potential for ventilatory depression emphasizes the need for close observation of patients receiving i.v. opioids by this technique.

Spinal anaesthesia or general anaesthesia for emergency hip surgery in elderly patients

One hundred and thirty-two elderly patients undergoing emergency hip surgery were randomly allocated to receive subarachnoid block (SAB) or general anaesthesia (GA). Using the 125.I fibrinogen uptake test, deep vein thrombosis was found to occur in 17 of 37 patients in the SAB group and 30 of 39 patients in the GA group (P 0.05). Blood loss was 513 ml (+/- SEM 44) in the SAB group and 714 ml (+/- SEM 67) in the GA group (P less than 0.01). Hypoxaemia was present preoperatively (mean PaO2 9.2 kPa). Immediately following general anaesthesia, the mean fall in PaO2 was 0.86 kPa compared with preoperative values but only 0.16 kPa following subarachnoid block (P less than 0.01). At 24 hours postoperatively the fall in PaO2 was similar in both groups and recovered only slowly during the first week. Twelve patients died, three in the SAB group and nine in the GA group. This difference in mortality was not statistically significant.

Warm peritoneal dialysis in the management of accidental hypothermia: report of five cases

Five patients with accidental hypothermia are reported. Admission rectal temperatures ranged from 24 degrees C to 31.7 degrees C and two patients had suffered circulatory arrest. Ages ranged between 25 and 77 and predisposing factors included alcoholism, gluterthimide poisoning, pancreatitis and cerebro-vascular accident. Along with respiratory and circulatory management in an intensive care unit the patients were actively rewarmed by peritoneal dialysis with fluid at 37 degrees C. Rewarming was rapid, smooth and free of complications. All five patients made a good recovery.

Aural thermometry during profound hypothermia

External auditory canal temperature changes during profound hypothermia were studied experimentally in ten dogs and clinically in 20 patients undergoing open-heart surgery. The results were compared with nasopharyngeal and lower oesophageal temperatures. Tympanic membrane temperature provided a better approximation to brain temperatures measured in four dogs to below 20 degrees C than did either of the other two methods. In patients, auditory canal temperature showed less variability with respect to oesophageal temperature and fell at a faster rate than did nasopharyngeal temperature. It did not appear to be subject to positional or other artefacts but four patients showed evidence of auditory canal trauma. The precise relationship between auditory canal or tympanic membrane temperature and brain temperature during profound hypothermia is not established. Routine otoscopic examination should accompany the use of an ear probe.

Deep vein thrombosis and anaesthetic technique in emergency hip surgery

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Radial artery cannulation. A prospective study in patients undergoing cardiothoracic surgery

Following 333 radial artery cannulations, the frequency of complete occlusion of the vessel on the day after removal of the annula was 30%, decreasing to 24% by the 8th day. Arterial occlusion was assessed using a modified Allen's test and an ultrasonic flow meter. The frequency correlated with the type and size of cannula used, being least (3%) with 20-gauge Teflon cannulae, with the degree of bruising, and with the sex of the patient, being significantly greater in women (37.5%) than in men (27%). Other variables such as insertion technique, low cardiac output, anticoagulation after operation and the duration of cannulation were assessed. Using multivariate analysis of 13 variables, it did not appear possible to predict with any certainty the outcome of arterial cannulation. The frequency of major complications was small and no permanent sequelae were detected.

Diving and hypothermia

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A nucleolar antigen found in a broad range of human malignant tumor specimens

With rabbit antibodies to nuclear 0.01 M Tris-HCl, pH 8, extract or "nucleolar preparations" of human HeLa S3 cells and fluorescein-labeled goat anti-rabbit antibodies, bright nucleolar immunofluorescence was observed in 61 or 63 human adenocarcinomas, squamous cell carcinomas, sarcomas, hematological neoplasms, and other malignant tumors. With these antibodies, nucleolar immunofluorescence was not found in 23 normal tissue specimens, 10 benign adenomas and hyperplastic tissues, and 8 specimens of inflammatory diseases. In the nontumorous tissues examined, positive nucelolar fluorescence was found in a few sections of a gastric ulcer and chronic ulcerative colitis which have been known propensities for malignant change; these areas may have been undergoing focal malignant changes.

Bacterial contamination of radial artery catheters

A prospective survey of 113 radial artery catheters showed a total contamination rate using an enrichment media culturing technique of 39%. The yield from routine culturing alone was only 9%. In six cases pathogenic bacteria were isolated. In this study no correlation between contamination and aspects of catheter insertion and management was shown.

Nucleolar antigen found in several human tumors but not in the nontumor tissues studied

Rabbit antibodies to nucleoli isolated from HeLa cells produced bright nucleolar fluorescence in HeLa cells by the indirect immunofluorescence technique. After absorption with fetal bovine serum and placental nuclei, the IgG still produced bright nucleolar fluorescence in 12 human tumor cells including HeLa, HEp-2, cultures of prostate and mammary carcinomas, the Goldenberg GW-39 colon tumor, and biopsy specimens of prostatic, adrenal cortical, thyroid, and squamous cell carcinomas, a hairy cell leukemia of the spleen, a hepatic metastasis of an adenocarcinoma of the colon, and an osteogenic sarcoma. Bright nucleolar fluorescence was not produced in nine nontumor human cells including biopsy specimens of bone marrow, kidney, placenta, thyroid, liver, and prostate, peripheral blood buffy coat, and cultures of normal skin fibroblasts. Nucleolar fluorescence with the absorbed IgG was prevented in HeLa cells by pretreatment of the cells with acid, base, and proteases but not by pretreatment with nucleases; absorption of this IgG with extracts of HeLa nucleoli prevented the nucleolor fluorescence in HeLa and other human tumor cells.

Purification and partial characterization of nucleolar antigen-1 of the Novikoff hepatoma

A nucleolar chromatin antigen (NoAg-1) found in Novikoff hepatoma but not in normal liver has been purified to homogeneity as shown by two-dimensional gel electrophoresis. Initial purification of NoAg-1 was partially achieved by isolation of nucleolar chromatin and fractionation of its proteins by successive extraction with solutions of increasing salt concentration. Further purification of this antigen was achieved by affinity and hydroxylapatite chromatography. Although approximately 50% of the NoAg-1 antigen was in the 0.6 M NaCl extract of Novikoff nucleoli, it was less pure than in the 2 M NaCl:5 M urea extract which contained 25% of the NoAg-1 at a purity of 40%. The highly purified NoAg-1 had an approximate molecular weight of 60,000 and pl of 5.1; the yield of NoAg-1 was 0.22% of the total nucleolar proteins.

Arachnoid cysts of the middle cranial fossa: surgical considerations

Three cases of arachnoid cysts of the middle cranial fossa are presented. CT imaging before and after peritoneal shunting of these cysts demonstrates the therapeutic value of this cerebrospinal fluid diversionary procedure. Many important facets of this disease such as cyst genesis, histology, natural history and other forms of therapy as reported by various authors in the recent literature are discussed.

Differences in nucleolar antigens of rat liver and Novikoff hepatoma ascites cells

Antisera to nucleoli of Novikoff hepatoma ascites and normal rat liver cells were produced in rabbits by injection of whole, isolated nucleoli. These antisera have been used to compare the nucleolar antigens that were partially fractionated by differential solubilization from nucleoli. Fourteen antigens were detected by these antisera; ten of these antigens were detected by both antisera. Ouchterlony double diffusion analysis of soluble extracts from normal rat liver and Novikoff hepatoma ascites nucleoli and fetal rat liver nuclei provided evidence for antigens found only in liver extracts, only in tumor extracts, or only in tumor and fetal extracts. Antisera preabsorbed to remove antibodies to common antigens of liver and tumor provided confirmatory evidence for one nucleolar antigen in liver that was not found in tumor or fetal rat liver, one antigen in tumor that was not found in adult or fetal rat liver, and three antigens in both tumor and fetal rat liver that were not found in adult rat liver. In addition, the antitumor nucleolar antiserum preabsorbed with liver nuclear extracts still produced positive nucleolar fluorescence in Novikoff hepatoma ascites cells but not in liver cells. Conversely, anti-liver nucleolar antiserum preabsorbed with tumor nucleolar extracts did not produce detectable tumor nucleolar fluorescence but did produce positive fluorescence in liver nucleoli.

Radial artery cannulation: influence of catheter size and material on arterial occlusion

A randomized, prospective trial of four different cannulae used for percutaneous radial artery cannulation was carried out in one hundred and forty-eight patients undergoing cardiopulmonary bypass surgery. Arterial occlusion was assessed using a modified Allen's test and an ultrasonic flow monitor. The incidence of complete occlusion eight days after decannulation was 34% for 18-gauge polypropylene and 0% for 20-gauge Teflon cannulae. Both the size and material of the cannula are important factors in the occurrence of arterial occlusion. This complication can largely be eliminated by the use of small Teflon cannulae.

Thermal balance during cardiopulmonary bypass with moderate hypothermia in man

In six patients undergoing coronary vein graft operations under cardiopulmonary bypass and hypothermia, the temperatures of arterial and mixed-venous blood, nosopharynx, oesophagus, liver, rectum, deltoid and vastus lateralis muscles and 10 skin sites were recorded. Whole-body oxygen consumption was measured before cooling and twice during hypothermia. On average, a patient lost 1000 kJ of heat by the end of hypothermia, of which 84% was lost to the heat-exchanger and pump circuit. Evaporative and convective loss amounted to 380 kJ, while the patient's metabolism supplied 220 kJ. During rewarming, the pump returned 670 kJ to the patient. Nasopharyngeal temperature reflected accurately venous, oesophageal and hepatic temperatures in the steady state; however, it was slow to reflect changes. Compared with other sites, muscle remains warmer during hypothermia and cooler after rewarming.

Nuclear matrix of HeLa S3 cells. Polypeptide composition during adenovirus infection and in phases of the cell cycle

A subnuclear fraction has been isolated from HeLa S3 nuclei after treatment with high salt buffer, deoxyribonuclease, and dithiothreitol. This fraction retains the approximate size and shape of nuclei and resembles the nuclear matrix recently isolated from rat liver nuclei. Ultrastructural and biochemical analyses indicate that this structure consists of nonmembranous elements as well as some membranous elements. Its chemical composition is 87% protein, 12% phospholipid, 1% DNA, and 0.1% RNA by weight. The protein constituents are resolved in SDS-polyacrylamide slab gels into 30-35 distinguishable bands in the apparent molecular weight range of 14,000 - 200,000 with major peptides at 14,000 - 18,000 and 45,000 - 75,000. Analysis of newly synthesized polypeptides by cylindrical gel electrophoresis reveals another cluster in the 90,000-130,000 molecular weight range. Infection with adenovirus results in an altered polypeptide profile. Additional polypeptides with apparent molecular weights of 21,000, 23,000, and 92,000 become major components by 22 h after infection. Concomitantly, some peptides in the 45,000-75,000 mol wt range become less prominent. In synchronized cells the relative staining capacity of the six bands in the 45,000-75,000 mol wt range changes during the cell cycle. Synthesis of at least some matrix polypeptides occures in all phases of the cell cycle, although there is decreased synthesis in late S/G2. In the absence of protein synthesis after cell division, at least some polypeptides in the 45,000-75,000 mol wt range survive nuclear dispersal and subsequent reformation during mitosis. The possible significance of this subnuclear structure with regard to structure-function relationships within the nucleus during virus replication and during the life cycle of the cell is discussed.

An experimental study of gaseous homeostasis and the Magill circuit using low fresh gas flows

Gas concentrations and ventilation levels have been measured within a conventional Magill circuit when conscious volunteers breathed a non-narcotic gas mixture at varying fresh gas flows. When evidence of rebreathing of alveolar gas was detected, the fresh gas flow was kept constant until a steady state developed. All subjects showed evidence of rebreathing when the fresh gas flow approached the predicted alveolar ventilation levels. A variety of subject-circuit interactions was seen and shown to be precipitated by naturally occurring breath-to-breath variations in ventilation. A single large breath could perturb the system. This could have a temporary effect, when the fresh gas flow was sufficient to wash the increased aliquot of expired carbon dioxide from the circuit. At other times a progressive response occurred as ventilatory stimulation as a result of the increased inspired carbon dioxide concentrations caused alveolar gas to reach the reservoir bag and converted the system behaviour from that of a simple added deadspace to that of a total mixing device. Whilst marked changes occurred commonly in both ventilation and inspired gas concentrations, only slight changes in end-tidal gas concentrations occurred.

Effect of sterol replacement in vivo on the fatty acid composition of Tetrahymena

The addition of ergosterol to cultures of Tetrahymena pyriformis results in (a) the accumulation of the sterol by the cells; (b) the inhibition of the synthesis of the pentacyclic triterpenoid alcohol, tetrahymanol; (c) the replacement of tetrahymanol by ergosterol in the ciliate membranes. The dry weight and lipid content of sterol-supplemented ciliates did not differ from the controls. Examination of the lipid classes revealed no change in composition except for a higher content of ergosterol in supplemented cells than tetrahymanol in control cultures. The relative proportions of triglycerides, the major classes of polar lipids, 1-alkyl phospholipids and phosphonolipids, appeared unaltered. A complex array of fatty acids is found in this ciliate. Several acids not reported previously in this organism were isolated and identified, and the novel fatty acid 18:2 delta 6, 11, was found in substantial amounts. Ergosterol supplementation altered the proportions of the fatty acids, although not all lipid classes were affected to the same extent. The changes noted were of three general types: (a) a shortening of the fatty acyl chain length in the acids of the normal series; (b) a lowering in the degree of unsaturation; (c) a discrimination between two isomers of lionoleate, 18:2 delta 6, 11 and 18:2 delta 9, 12. The former is elevated in the presence of ergosterol while the latter is depressed. Each class of polar lipids has a distinctive fatty acid composition. Among the glycerophospholipids, cardiolipin and phosphatidylcholine were least affected, while the mixture of 1-alkyl-2-acyl-sn-glycero-3-(2-aminoethyl)-phosphonate and 1,2-diacyl-sn-glycero-3-(2-aminoethyl)-phosphonate was most markedly altered. Sphingolipid fatty acid composition was influenced by ergosterol supplementation. Two changes were noted: (a) a reduction in the length of the hydrocarbon chain; (b) an increase in the proportion of alpha-hydroxy acids. The impact of ergosterol on the fatty acid composition of the polar lipids may be on fatty acid biosynthesis, on incorporation of fatty acids, or on the turnover rates of the fatty acyl groups. Ergosterol is concentrated in the ciliary (limiting) membrane, as are the polar lipids most affected. This localization allows the speculation that the change in fatty acid composition may be related to the maintenance of optimal membrane properties upon the introduction of the sterol.

Diver performance: the effect of cold

Fifteen divers performed five tasks in water of temperatures 20 degrees C and 5 degrees C, using standard scuba equipment. A significant deterioration of performance occurred under the colder condition in: simple arithmetic 13%; logical reasoning 17%; word recall 37%; word recognition 11%; and manual dexterity 17%. Throughout each dive, rectal and five skin temperatures were monitored. Average fall in rectal temperature was 0.5 degrees C during 20 degrees C dives and 1.1 degrees C during 5 degrees C dives. Average body surface temperature fell by 5 degrees C and 12.5 degrees C respectively. Average heat losses calculated from the data were 95 kcal.m(-2).hr(-1) (20 degrees C dives) and 245 kcal.m(-2).hr(-1) (5 degrees C dives). The impairment in word recognition was significantly correlated with the fall in rectal temperature for the 5 degrees C dives. For other tests, the deterioration did not appear to be correlated with body-temperature changes, but rather, occurred rapidly upon cold water immersion. The significance of these findings is discussed in relation to current understanding of the mechanisms by which cold is thought to influence performance underwater.

Establishing a private practice in neurological surgery; preparations, problems and pitfalls

In summary, the young neurosurgeon entering private practice will find he will have to make many non-medical decisions for which he has had little or no preparation during the course of his lengthy training. Just as one spends time planning a careful curriculum in leading to the specialty of neurological surgery, he must also dedicate many hours to establishing a private practice in that specialty. The time spent in investigating these problems in advance will minimize the frustrations in attaining the goal which we are all striving to achieve-personal satisfaction in the delivery of excellent health care.